Poverty is strongly related to disparities in early child development, school readiness and educational achievement. The early emergence and long-term persistence of disparities underscore the need for effective interventions prior to school entry. Responsive parenting is a promising target for interventions to reduce these disparities. While home visitation programs have potential to influence parenting, access to populations and costs are barriers to implementation. Pediatric primary health care is an innovative opportunity to promote parenting with potential for universal access to the preschool (0-5 year) population and low cost by building on existing infrastructure. The Video Interaction Project (VIP) is designed to leverage the opportunity presented by pediatric primary health care in order to reduce achievement gaps in low SES children through promotion of responsive parenting. VIP's core strategy involves a child development specialist who coaches the parent during videotaped interactions utilizing provided toys and books; review of tapes is used to facilitate and reinforce interactions. Use of VIP strategies at home is facilitated by providing the parent with the tape as well as learning materials and parenting pamphlets incorporating parents' observations and plans. In the first cycle of NIH funding, we performed an RCT that found major benefits resulting from VIP 0-3 (the original 0 to 3 year program) related to responsive parenting and early child development; many effect sizes were in the .3 to .6 range, remarkable for a parenting intervention. These results suggest that VIP is a highly-promising, evidence- based intervention for addressing children's poverty-related developmental and educational disparities. Longitudinal and intervention studies suggest that further enhancement of responsive parenting during the preschool 3-5 year period has potential for additional impact on school readiness, particularly for low SES families whose children are at greatest risk but who have less access to high quality preschool programs. We therefore developed a new preschool component of VIP for 3-5 year old children (VIP 3-5). VIP 3-5 has an expanded focus to help parents engage their children in increasingly rich levels of pretend play and early literacy activities, adding new elements adapted from evidence-based preschool programs for parents to use pretend play and shared reading. This continuation will assess the impact of VIP from birth to 5 years, building on the existing cohort. Families originally receiving VIP 0-3 or in the 0-3 year Control group will be re- randomized at age 3 years to either VIP 3-5 or to a 3-5 year control group. This study design will allow testing of the impact of VIP (0-3, 3-5, and combined) and determination of whether this already-trialed intervention leads to significant improvements in children's long term academic and social-emotional wellbeing. It will also allow testing of critical questions related to optimal timing and dose of parenting intervention during the years prior to school entry. Findings will have broad public health implications related to the role of pediatric primary health care in the promotion of early child development and school readiness in children at risk due to poverty. PUBLIC HEALTH RELEVANCE: The early emergence and long-term persistence of poverty-related disparities in early child development, school readiness and educational achievement underscore the need for effective interventions prior to school entry. We developed the Video Interaction Project (VIP) to leverage the opportunity presented by pediatric primary health care (potential for universal access to the preschool population, low cost by building on existing infrastructure) in order to reduce poverty-related disparities through promotion of responsive parenting. Findings will have broad public health implications related to the role of pediatric primary health care in the promotion of early child development and school readiness in children at risk due to poverty.